Epistaxis Overview and Types

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Questions and Answers

What is the recommended duration for keeping nasal sponges in place without antibiotics?

48-72 hours.

What are the two main indications for performing posterior nasal packing?

Failed anterior packing and bleeding from the major branch of the sphenopalatine artery.

What is the primary purpose of using systemic antibiotics in nasal bleeding management?

To prevent infection and toxic shock syndrome.

What invasive procedure can be performed when epistaxis is refractory to other treatments?

Arterial embolization. Signup and view all the answers

What is the recommended sedation medication and dosage for patients experiencing anxiety before nasal procedures?

50-100 mg of pethidine injection. Signup and view all the answers

What term is used to describe the acute hemorrhage from the nostril, nasal cavity, or nasopharynx?

Epistaxis. Signup and view all the answers

What are the two main types of epistaxis and which age groups do they predominantly affect?

Anterior epistaxis is more common in children and young adults, while posterior epistaxis is more common in older individuals. Signup and view all the answers

Identify two local causes of epistaxis mentioned in the material.

Trauma (e.g., nose picking) and neoplasms (e.g., inverted papilloma). Signup and view all the answers

In the evaluation of the cause of epistaxis, which factors should be assessed?

Onset, duration, frequency, amount, side, type, medical history, family history, and drug history. Signup and view all the answers

What initial first aid measures should be taken for a patient experiencing epistaxis?

Clean the area using the Hippocratic technique; if no response, consider simple cautery. Signup and view all the answers

Which medications or substances are known to be contributors to epistaxis?

Aspirin, anticoagulants, and topical steroids. Signup and view all the answers

What symptom can occur if severe epistaxis leads blood to drain into the stomach?

Nausea and vomiting. Signup and view all the answers

What procedures might be required to stop continued bleeding in cases of epistaxis?

Cautery, anterior or posterior packing, embolization, or ligation of the maxillary or ECA. Signup and view all the answers

What are the key initial first aid measures to be taken for a patient experiencing epistaxis?

Pinch the nose tightly, maintain an upright position, and lean forward. Signup and view all the answers

How can the type of epistaxis bleed be differentiated between anterior and posterior?

The location of the bleeding site on the nose indicates whether it is anterior or posterior. Signup and view all the answers

What medical history is relevant when assessing a patient with epistaxis?

History of medical ailments like hypertension, leukaemia, and any known bleeding tendencies. Signup and view all the answers

What are the advantages of using cauterization for treating epistaxis?

Cauterization is quick, easy, and does not require nasal packing. Signup and view all the answers

What precautions should be taken during the procedure to stop bleeding?

Wear gloves, a gown, and eye protection while ensuring good light and patient comfort. Signup and view all the answers

Describe the process of chemical cauterization using silver nitrate.

Hold the silver nitrate stick in contact with the bleeding site for several seconds until it turns grayish-white. Signup and view all the answers

What differences exist between anterior packing and cauterization for treating epistaxis?

Anterior packing is used for acute or recurrent bleeding that doesn't respond to treatment, while cauterization targets visible bleeding points. Signup and view all the answers

What should not be done during cauterization procedures for epistaxis?

Bilateral cauterization at the same time should be avoided to prevent complications like perforation. Signup and view all the answers

What common idiopathic condition is associated with epistaxis aside from trauma?

Sarcoidosis Signup and view all the answers

Explain the physiological link between stress and epistaxis related to hypertension.

Stress and anxiety release adrenaline, activating the sympathetic system, which raises blood pressure during an epistaxis episode. Signup and view all the answers

Identify two types of neoplasms that are associated with epistaxis.

Inverted papilloma and Angiofibroma Signup and view all the answers

What initial first aid measures should be taken in a case of epistaxis?

Clean and apply the hippocratic technique, then consider simple cautery if there is no response. Signup and view all the answers

What assessments are necessary to evaluate blood loss during an episode of epistaxis?

Vitals, sweating, pallor, IV line placement, and cross-matching with baseline packed cell volume (PCV). Signup and view all the answers

Name two iatrogenic causes of epistaxis.

Nasal gastric tube insertion and topical steroid use. Signup and view all the answers

What is the role of embolization in the management of epistaxis?

Embolization is used to stop continued bleeding by occluding the blood vessels supplying the nasal area. Signup and view all the answers

List three essential questions to assess the mode of onset in a case of epistaxis.

Determine if the onset was spontaneous or due to trauma, how long it has lasted, and its frequency. Signup and view all the answers

Study Notes

Epistaxis Definition

Bleeding from the nostril, nasal cavity, or nasopharynx
Common ED complaint
Often causes anxiety in patients and doctors

Types of Epistaxis

Anterior: More common, more prevalent in children and young adults
Posterior: Less common, more prevalent in older individuals, more likely to require medical attention
Bimodal: Common in individuals aged 50 years and older, more prevalent in the winter and early morning

Causes of Epistaxis

Local: The most common cause is idiopathic. Other causes include trauma (nose picking, nasal blowing, sneezing, NG tube), neoplasms (inverted papilloma, angiofibroma, squamous cell carcinoma), and topical medications (steroids, cocaine).
General: Includes bleeding disorders (coagulopathy, platelet disorders), drugs (aspirin, anticoagulants), and other idiopathic causes (e.g., sarcoidosis).

Relationship between Hypertension and Epistaxis

Epistaxis is more frequent in hypertensive patients
Patients are more likely to experience acute hypertension during an epistaxis episode
Hypertension is rarely a direct cause of epistaxis
Treat hemorrhage before lowering blood pressure

Management of Epistaxis

Initial First Aid Measurements:
- Pinch the nose tightly
- Lean forward to avoid swallowing blood
- Sit upright to decrease blood pressure
- If epistaxis persists, admit to the hospital and proceed with further steps
Assessment of Blood Loss:
- Assess vital signs (heart rate, blood pressure)
- Look for pallor and sweating
- Insert IV line
- Cross-match blood
- Determine baseline hematocrit
Evaluation of the Cause:
- Determine onset, duration, frequency, amount, side, type of bleeding
- Gather medical history, family history, and drug history
Procedures to Stop Continued Bleeding:
- Cautery:
  - Chemical (silver nitrate): helpful for mild bleeding
  - Electrical (monopolar, bipolar, suction): not used
  - Laser: for vascular malformations
  - Endoscopic: for posterior bleeding points
- Packing:
  - Anterior: For acute or recurrent bleeding not responding to medical or cauterization treatments. Types include vaseline ribbon gauze, BIPP, merocel Pope or Kennedy nasal sponges, gelfoam, and surgicel.
  - Posterior: For failed anterior packing or bleeding from a major branch of the sphenopalatine artery. Types include gauze impregnated with BIPP, Foley catheter, and nasal balloon.
- Other Measures:
  - Embolization: For refractory cases of epistaxis.
  - Endoscopic sphenopalatine artery ligation (ESPAL): Often recommended as first-line surgical treatment when conservative measures have been unsuccessful.
  - Arterial ligation:
    - External carotid artery
    - Maxillary artery
Role of Sedation:
- Use pethidine injection (50-100 mg) to alleviate fear and anxiety in the patient.

Complications of Epistaxis

Toxic shock syndrome
Infection

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Description

Explore the definition, types, and causes of epistaxis, a common medical condition characterized by nosebleeds. This quiz will also delve into the relationship between hypertension and epistaxis, helping you understand its implications in various age groups. Perfect for medical students and healthcare professionals!